Organization Active NPI

Medhub

  • Internal Medicine Physician
  • Woodstock, GA
National Provider Identifier
1912703166
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MEDHUB
Practice address
3203 S Cherokee LN Ste 220
Woodstock, GA 30188-4461
Phone
(770) 675-6025
Fax
(770) 676-7814
NPI assigned
Feb 19, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ravindranath Nallamothu, MDNPI 1679724033
Title
Ceo
Phone
(770) 675-6025

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

3203 S Cherokee LN Ste 220
Woodstock, GA 30188-4461

Mailing address

3203 S Cherokee LN Ste 220
Woodstock, GA 30188-4461
Phone (770) 675-6025

Other practice location 1

5835 Campbellton Rd SW Ste 201
Atlanta, GA 30331-8014
Phone (770) 675-6025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250422002542 GA Part B Supplier - Clinic/Group Practice 0042735060 Receives reassigned benefits from 4 practitioners
Practice locations: Atlanta, GA; Sandy Springs, GA; Woodstock, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2329551Medhub3203 S Cherokee Lane, Suite 220, Woodstock, GA 30188Certificate of waiverAug 29, 2027
11D2330157Medhub5835 Campbellton Road SW, Suite 201, Atlanta, GA 30331Certificate of waiverSep 10, 2027

National Provider Directory

National Provider Directory

Locations

5835 Campbellton Rd SW
Ste 201
Atlanta, GA 30331
Phone (404) 334-0696

5975 Roswell Rd
Ste A105
Sandy Springs, GA 30328
Phone (404) 696-4141

3203 S Cherokee Ln
#220
Woodstock, GA 30188
Phone (770) 675-6025

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765152000000",
    "number": "1912703166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3203 S CHEROKEE LN STE 220",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884461",
            "telephone_number": "770-675-6025",
            "fax_number": "770-676-7814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3203 S CHEROKEE LN STE 220",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884461",
            "telephone_number": "770-675-6025",
            "fax_number": "770-676-7814"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5835 Campbellton Rd SW Ste 201",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303318014",
            "country_code": "US",
            "telephone_number": "770-675-6025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEDHUB",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-19",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A",
        "authorized_official_last_name": "NALLAMOTHU",
        "authorized_official_first_name": "RAVINDRANATH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-675-6025",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.